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Infliximab Appears to Improve Sleep in Rheumatoid Arthritis Independent of Effects on Joint Pain
A DGReview of :"Effect of the first infliximab infusion on sleep and alertness in patients with active rheumatoid arthritis"
Annals of the Rheumatic Diseases (ARD Online)
12/24/2003
By Emma Hitt, PhD
Infliximab treatment appears to improve disturbances to sleep and alertness in patients with rheumatoid arthritis (RA), and this improvement is unrelated to improvement in joint discomfort, researchers write.
Patients with RA have increased circulating levels of tumour necrosis factor (TNF)-alpha, which may be one of the elements causing the sleep disorders noted in these patients.
To evaluate this issue further, Carlos Zamarron, MD, and colleagues, Hospital Clínico Universitario and Medical School, Universidad de Santiago de Compostela, Spain, assessed the benefit of an infliximab infusion on sleep disturbances in six women with RA.
The day after the first infliximab infusion, the mean number of tender or swollen joints and morning stiffness remained unchanged. However, the median number of total sleep stage transitions per hour improved significantly compared to before infusion (P = .014).
Median percentage of phase I and II sleep also improved (P = .023), as did the percentage of REM stages (P = .014), median percentage sleep efficiency (P = .014), median sleep latency (P = .023), and median number of hits in the steer clear test (P = .023). Neither objective nor subjective daytime sleepiness was noted, the researchers point out.
"The results of this study suggest that the sleep and alertness disturbances in patients with RA improve with the use of infliximab," Dr. Zamarron and colleagues conclude.
The prompt response to the antibody suggests that TNF-alpha played a key role in the patients' sleep disturbances, according to the authors. "Raised circulating levels of TNF-alpha are found in RA and other conditions, such as HIV-AIDS, where alterations in sleep have been documented," they write.
"The improvement does not appear to reflect joint pain amelioration but seems rather to be a central nervous system effect due to inhibition of raised circulating levels of TNF-alpha," they add.
Ann Rheum Dis. 2004;63:88-90.
"Effect of the first infliximab infusion on sleep and alertness in patients with active rheumatoid arthritis"
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